Continuous glucose monitoring (CGM) facilitates the assessment of short-term glucose variability and identification of acute excursions of hyper- and hypo-glycemia. Among 37 diabetic hemodialysis patients who underwent 7-day CGM with the iPRO2 device (Medtronic Diabetes, Northridge, CA, USA), we explored the accuracy of glycated albumin (GA) and hemoglobin A1c (HbA1c) in assessing glycemic control, using CGM-derived metrics as the reference standard. In receiver operating characteristic (ROC) analysis, the area under the curve (AUC) in diagnosing a time in the target glucose range of 70–180 mg/dL (TIR^70–180) in <50% of readings was higher for GA (AUC: 0.878; 95% confidence interval (CI): 0.728–0.962) as compared to HbA1c (AUC: 0.682; 95% CI: 0.508–0.825) (p < 0.01). The accuracy of GA (AUC: 0.939; 95% CI: 0.808–0.991) in detecting a time above the target glucose range > 250 mg/dL (TAR^>250) in >10% of readings did not differ from that of HbA1c (AUC: 0.854; 95% CI: 0.699–0.948) (p = 0.16). GA (AUC: 0.712; 95% CI: 0.539–0.848) and HbA1c (AUC: 0.740; 95% CI: 0.570–0.870) had a similarly lower efficiency in detecting a time below target glucose range < 70 mg/dL (TBR^<70) in >1% of readings (p = 0.71). Although the mean glucose levels were similar, the coefficient of variation of glucose recordings (39.2 ± 17.3% vs. 32.0 ± 7.8%, p < 0.001) and TBR^<70 (median (range): 5.6% (0, 25.8) vs. 2.8% (0, 17.9)) were higher during the dialysis-on than during the dialysis-off day. In conclusion, the present study shows that among diabetic hemodialysis patients, GA had higher accuracy than HbA1c in detecting a 7-day CGM-derived TIR^70–180 < 50%. However, both biomarkers provided an imprecise reflection of acute excursions of hypoglycemia and inter-day glucose variability.

Background: Vascular access (VA) is one of the most critical procedures during dialysis for patients with end-stage renal disease (ESRD), as it influences morbidity, mortality, and quality of life. Methods: This cross-sectional study analyzed the vascular access epidemiology of patients undergoing chronic HD in 15 nephrology centers across Greece from 2013 to 2019. Data on VA type, demographic characteristics, fatigue severity, and quality of life were gathered from a sample of 373 patients. Results: The prevailing result of this study is that arteriovenous fistula (AVF) was the commonly practiced VA, and its associated survival outcomes were better when compared to arteriovenous grafts (AVGs) and central venous catheters (CVCs). Patients with AVFs had significantly longer survival times (median 165 months) compared to non-fistula access. Furthermore, the degree of fatigue and quality of life were also dependent on the type of VA used, with patients on AVF having lower fatigue levels and better quality of life. Age, gender, and an early nephrologist referral were noted to affect the selection and the rate of maturation of VA. Despite AVF being the preferred VA, late referrals and high initial reliance on CVCs remain challenges. Conclusions: This study underscores the need for early nephrological intervention, surveillance programs, and patient education to optimize vascular access outcomes. Future research should focus on national strategies to reduce CVC-related complications and improve long-term HD care in Greece.

Background: Diabetic nephropathy (DN) is a leading cause of end-stage renal disease, arising from complex interactions between metabolic, hemodynamic, and genetic factors. Among candidate genes, vascular endothelial growth factor A (VEGFA) has been extensively investigated due to its role in endothelial homeostasis and microvascular complications of diabetes. The present study aimed to examine the association of VEGFA polymorphisms with DN in a Greek population and to perform a comprehensive meta-analysis of available evidence. Methods: A case–control study was conducted, including 197 patients with type 2 diabetes mellitus (T2DM) and DN, 155 diabetic patients without nephropathy, and 246 healthy controls. Ten tagging single-nucleotide polymorphisms (SNPs) across VEGFA were genotyped. Statistical analyses employed the generalized odds ratio (OR_G). To contextualize these findings, a meta-analysis of 13 eligible studies was performed, encompassing 7520 cases, 6951 diabetic controls, and 1718 healthy controls. Results: Of the tested variants in the present case–control study, only rs833070 was significantly associated with DN across all comparisons. Nine VEGFA variants were evaluated in meta-analysis, with rs2146323 showing a protective effect (allelic OR = 0.85; 95% CI: 0.76–0.95), while other variants yielded non-significant associations. Conclusions: Overall, the data suggest that VEGFA polymorphisms, particularly rs833070 and rs2146323, contribute to genetic susceptibility to DN, although population-specific differences and heterogeneity across studies remain substantial. Future research in large, ethnically diverse cohorts with functional analyses is warranted to clarify causal mechanisms and enable the integration of VEGFA genetic variation into risk stratification and personalized therapeutic strategies.

Background: Diabetic nephropathy (DN) is a major microvascular complication of diabetes mellitus with a strong genetic component. The aldo-keto reductase family 1 member B (AKR1B1) gene has been implicated in hyperglycemia-induced renal damage. This study aimed to investigate the association between AKR1B1 variants and DN through a genetic association study (GAS) and a comprehensive meta-analysis. Methods: A case–control study was conducted in a Greek population, including 190 DN patients, 150 T2DM patients without nephropathy, and 238 healthy controls. Five tagging single-nucleotide polymorphisms (SNPs) in AKR1B1 were genotyped. Associations were assessed using the generalized odds ratio (OR_G). A systematic literature search was performed, and eligible studies were included in a meta-analysis using a random-effects model. Results: In the case–control study, none of the examined SNPs showed a significant association with DN in any comparison model. However, meta-analysis results demonstrated a significant association for the promoter variant −106 C>T (rs759853) in diabetic individuals without nephropathy versus DN cases (OR_G = 1.389, 95% CI: 1.134–1.700). The (CA)n polymorphism showed a non-significant overall effect but was associated with increased risk in subgroups of Asians (OR_G = 1.455, 95% CI: 1.042–2.032) and T2DM patients (OR_G = 1.357, 95% CI: 1.039–1.771). No associations were observed when healthy controls were used. Conclusions: While no significant associations were detected in the single-cohort analysis, meta-analytic evidence supports a role of regulatory AKR1B1 variants in DN susceptibility. These findings highlight the importance of control selection and suggest that AKR1B1 may influence progression to nephropathy rather than diabetes risk per se.

Cardiovascular disease (CVD) remains the leading cause of mortality among hemodialysis (HD) patients, underscoring the need for reliable biomarkers for early diagnosis and management. Serum intercellular adhesion molecule-1 (ICAM-1) has been investigated for years as a potential CVD marker but has yet to establish clinical utility. In a cohort of 142 HD patients, we examined the potential of serum ICAM-1 as a CVD biomarker and evaluated whether confounding factors, including low-grade inflammation and chronic kidney disease–mineral bone disorder (CKD-MBD), limit its diagnostic value. In addition to serum ICAM-1, routine biochemical parameters, bone alkaline phosphatase (bALP), and nitric oxide (NO) were measured. Serum levels of ICAM-1, bALP, and NO did not differ between patients with and without CVD, defined by a positive history of coronary heart disease, stroke, or peripheral arterial disease. Serum ICAM-1 concentrations were higher in HD patients with inflammation, as indicated by C-reactive protein levels >1 mg/dL. ICAM-1 showed no correlation with NO, a marker of endothelial dysfunction, but was positively correlated with bALP, a marker of CKD-MBD. In conclusion, serum ICAM-1 is not a reliable biomarker of CVD in HD patients. Its diagnostic utility appears confounded by inflammation and disturbances in bone turnover.

Background: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is released in response to increased cardiac wall stress and is used as a biomarker for volume overload and heart failure (HF). It is also elevated in atrial fibrillation (AF) and inflammation. However, in hemodialysis (HD) patients, its interpretation is complicated by reduced renal clearance, large fluid shifts between dialysis sessions, and chronic inflammation. Methods: In 123 HD patients, we examined the relationship between NT-proBNP and interdialytic weight gain, HF with preserved ejection fraction (HFpEF), left ventricular systolic dysfunction (LVSD), and AF, as well as the impact of inflammation. Clinical characteristics, laboratory data, and echocardiography (within three months) were evaluated, while serum NT-proBNP and calprotectin levels were measured by ELISA. Results: NT-proBNP showed no association with interdialytic weight gain and did not identify HFpEF. Inflammatory markers (C-reactive protein and calprotectin) correlated positively with NT-proBNP. Multivariable analysis demonstrated that LVSD, AF, and inflammation remained independent predictors of NT-proBNP levels. Although NT-proBNP levels were higher in LVSD, its diagnostic performance was poor (AUC 0.627). In contrast, NT-proBNP was significantly elevated in patients with AF and showed good diagnostic performance (AUC 0.801). Conclusions: In HD patients, NT-proBNP is not correlated with interdialytic weight gain, performs poorly as a marker of LVSD, but may serve as a useful marker of AF.